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Randomized Controlled Trial
. 2015 May 9:15:40.
doi: 10.1186/s12894-015-0032-7.

Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study

Ching-Hsin Chang  1   2   3 , Tzu-Ping Lin  4   5   6 , Yen-Hwa Chang  7   8   9 , William J S Huang  10   11   12 , Alex T L Lin  13   14   15 , Kuang-Kuo Chen  16   17   18
Affiliations
Randomized Controlled Trial

Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study

Ching-Hsin Chang et al. BMC Urol. .

Abstract

Background: Prostate vaporization and enucleation is a novel treatment option for bladder outlet obstruction caused by benign prostate enlargement. This surgical technique, however, has not yet been standardized. We present our findings of using a high-power thulium laser to accomplish vapoenucleation of the prostate (ThuVEP).

Methods: We prospectively collected and analyzed data from 29 patients who underwent ThuVEP between August 2010 and May 2012. The control group included 30 patients who underwent traditional transurethral resection of the prostate (TURP). Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume (measured using transrectal ultrasonography), and the international prostate symptom score (IPSS) were recorded and analyzed using a two-tailed Student's t-test and analysis of variance.

Results: The ages (mean ± SD) of the patients were 76.1 ± 9.4 and 72.6 ± 7.4 years (p = 0.28) in the ThuVEP and TURP groups, respectively. The average urinary flow rates before and 12 months after the operation (volume/maximum flow/average flow) were 243.3/10.5/5.0 and 302.8/17.6/9.4 (in mL, mL/s, mL/s, respectively) in the ThuVEP group and 247.2/10.8/4.6 and 369.9/20.8/12.0, respectively, in the TURP group. Preoperative and postoperative IPSSs were 17.1 ± 5.0 and 6.5 ± 3.8, respectively, in the ThuVEP group and 18.2 ± 4.5 and 6.2 ± 3.3, respectively, in the TURP group. The mean ratio of the estimated postoperative residual prostate volume to the preoperative total volume was 0.47 (p = 0.449) in both groups. The overall complication rate was 20.7% in the ThuVEP group and 30.0% in the TURP group.

Conclusions: One year of follow-up showed that ThuVEP and TURP effectively alleviated subjective and objective voiding symptoms with a low rate of complications. Thus, vapoenucleation using a high-power laser is feasible in elderly patients.

Trial registration: ISRCTN registry with study ID ISRCTN52339705 . Date assigned: 06/03/2015.

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Figures

Figure 1
Figure 1
Overall laser system used. A: Quanta thulium surgical laser system. B: View from the guiding tube. C: Procedure for laser enucleation with the guiding tube. The median lobe was elevated using the guiding tube. Thus, the surgical plan used tension to further facilitate precise incision of the surgical capsule.
Figure 2
Figure 2
International prostate symptom score (IPSS). No statistical differences were observed between the two groups.
Figure 3
Figure 3
Uroflowmetry (UFR). A: Maximum urinary flow rate (Qmax) according to the UFR test data. No statistical differences were observed in the two groups. B: Postvoid residual volume in the UFR test data. All variables improved significantly in the two groups after the operation without statistical differences at later follow-up examinations.
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